| National Provider Identifier [NPI]: | 1235370743 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.M.S., PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 MEMORIAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELLEVILLE |
| Zip Code Of The Provider | 622265360 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 328 |
| Number Of Medicare Beneficiaries | 292 |
| Total Submitted Charge Amount | 143217 |
| Total Medicare Allowed Amount | 35508.12 |
| Total Medicare Payment Amount | 27126.57 |
| Total Medicare Standardized Payment Amount | 30800.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 328 |
| Number Of Medicare Beneficiaries With Medical Services | 292 |
| Total Medical Submitted Charge Amount | 143217 |
| Total Medical Medicare Allowed Amount | 35508.12 |
| Total Medical Medicare Payment Amount | 27126.57 |
| Total Medical Medicare Standardized Payment Amount | 30800.99 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 118 |
| Number Of Beneficiaries Age 65 to 74 | 93 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 176 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 162 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 160 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 132 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5944 |